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Centre for Clinical Microbiology

The Centre for Clinical Microbiology at UCL combines internationally renowned academic, research and clinical expertise in microbiology.

Centre Director:Professor Timothy D McHugh, Graduate Tutor for the Faculty of Medical Science, Academic Lead for the School of Life and Medical Sciences CPD programmes.

The Centre for Clinical Microbiology (CCM) is a constituent research group in the Research Department of Infection within the Division of Infection and Immunity and its UCL staff are located at the Royal Free Campus.

Members of the Centre are also at UCLH and Royal Free Hospital London NHS Trust Departments of Medical Microbiology and many of our staff hold joint or honorary appointments across the institutions. Through research collaborations and joint appointments CCM also includes colleagues from Public Health England (PHE).

Our Centre

It is almost half way through 2013 as I write this review of
2012; it was a busy year and it has taken me some time to ‘take stock’. The
consolidation of the Centre for Clinical Microbiology at the Royal Free Campus
provided us with great opportunities for collaborative working and importantly
enabled previously disparate teams to understand each other’s work. In the near
future this will be reflected in applications for research funding but in the
short term it had an immediate effect on the breadth of the research projects
we offered out MSc and BSc students. As is often the case the preliminary work
undertaken by project students lays the foundation for funding applications and
further development.

Research in the Centre is organised around 4 key themes and
colleagues have updated me on the progress in each area:

HCAI

In addition to running HCAI meetings and several MSc student
projects, this group has been active in a number of projects aimed at reducing
transmission of infection. The site and origin of bacterial reservoirs in wards
have been identified and investigated. A important focus of transmission is the
ward based computer key board and the HCAI group have developed software to
encourage users to clean their keyboards as well as photolytic coatings for
keyboards that significantly reduce bacterial contamination in normal ward
lighting conditions.

Clostridium difficile is a
significant concern in our partner hospitals and the group have been focussed
on improvement of both diagnostics and disinfectants for the control of this
infection. This is underpinned by a PhD project, in collaboration with Public
Health England and LSHTM, exploring the bacterial population structure of C. difficile locally and globally.

Further work addressing the rapid detection of antibiotic
resistance in Enterobacteriaceae has been a focuss of our clinical service and
funding by a Pfizer Antiinfectives Research Grant has enabled a Clinical Fellow
to innovate in this area with mass spectrometry.

TB

2012 continued to be a successful year for the TB group; 2
projects were funded and initiated; INFECT-MET funded by the EMRP (EU) to
develop high order metrology for infectious disease diagnostics. We provide
expertise in molecular diagnosis of respiratory bacteriology. PreDICT-TB (website) an IMI
(EU) funded project with partners which aims to develop robust pathways to
evaluation of new drug combinations for treatment of tuberculosis. Our
contribution is in the application of the Molecular Bacterial Load assay, developed
in our Centre, to enumeration of the treatment effect in in vitro and in vivo
models as well as the use of transcriptomic approaches for the understanding of
the mechanism of drug action in vivo.

REMoxTB continues to be a
major activity in the Centre and this clinical trial completed recruitment in
January 2013 with 1931 patients. The last patient will complete the study in
July 2013 and the results will be reported in the first months of 2014. We have secured further funding to ensure
stability for staff and indeed have expanded the team to ensure a timely
conclusion to this important study. One of the major outputs of REMOxTB will be
the laboratory manual which enabled us to standardise methods across 3
countries and we have been given further funding to develop this into a
universal laboratory manual for TB clinical trials.

TB research in UCL is not just located in the Centre and so we
have instigated UCL-TB (www.ucl.ac.uk/tb)
to encourage communication and collaboration in TB research across the College. The
strength of TB research at UCL was reflected by the World TB Day event, led by
myself, Professor Ali Zumla and Dr Marc Lipman (WTBD 2013), the 2012 event saw the
launch of a special supplement to the Journal of Infectious Diseases, edited by
Professor Zumla (LANCET).

Education

The Centre is the home for 3 MSc programmes. The MSc Infection &
Immunity is now well established with our students in demand for PhD
programmes and research assistant posts.

Our MSc Medical
Mycology programme was the first of its
kind in the world (and remains the only course offering blended learning from
international experts in the field) and we are proud that it is in its 10th
year.
The MSc/PG
Dip in Healthcare associated Infection Control, entered
its second year, with numbers growing and increased interest in this blended
learning programme which allows practitioners to access their learning when
their professional schedule allows.

I am pleased to note that Mr Marcus Leung has been awarded his
doctorate and our current compliment of current research students to 15 (9 in
I&I) working from the RF, PHE Colindale, PHE Porton Down, Barts &
London and Jamaica.

Mycology

We continue to innovate in the
area of rapid fungal diagnostics and MALDI-ToF has been a natural centre of
attention over the last year. Comparative studies using this technology ,
PNA-FISH and conventional molecular methods –have led to presentations at
national and international meetings with the prize for best oral presentation going
to Rebecca Gorton (PhD student and Clinical Scientist) at the British
Society for Medical Mycology (BSMM) annual
scientific meeting.

Clinical studies feature
strongly in this work package and these include ; clinical studies of
antifungal prophylaxis strategies, radiological studies and novel
immunodiagnostics for invasive mould infections are in progress and some early
data have been presented at international conferences. Two major studies that
the Centre has made substantial contributions to are the 60,000 patient ICU
Candida study and the, now completed, 1000 patient European study on invasive mould disease in patients with
haematological malignancy.

The clinical research experience
of this group is reflected in publication of national and international
guidelines on diagnosis and management of fungal infection and the re-election of Professor Chris Kibbler for a further year as President of the British
Society for Medical Mycology.

Molecular diagnosis

Molecular diagnosis underpins much of the work of the Centre but
as a work package on its own it accounts for a substantial output from the
team. In 2012 Professor Zumla was awarded an EU FP7 award RiD-RTI [see "News, Media Coverage & Outreach" section] , to develop new rapid diagnostics for
respiratory infections. This initiative includes partners from across Europe
and takes a syndromic approach to diagnosis of infection.

Working with the Academic Centre for Respiratory Medicine we
continue to support a substantial effort considering the role of infection in COPD with Respiratory
Medicine for which I lead the microbiology.

Together with Prof Andrew Burroughs (Liver unit), Dr Ronnie
Chee (Consultant Immunologist) at the Royal Free and Dr Harry Antoniades
(Imperial College), Dr Bambos Charalamabous is investigating the translocation of bacterial products
from the gut into the systemic circulation in liver disease patients as a
biomarker of outcome. With an MSc in Infection & Immunity student the team have
optimised a molecular based method to extract and quantitate bacterial DNA from
blood alongside the determination of viable bacteria.

London is a cosmopolitan city and this provides an exciting environment to study infectious diseases, however, our work in London is placed into a global context by our international collaborations of which our relationships with UTH, Lusaka, Zambia (led by Professor Zumla) and KCMC, Moshi, Tanzania (led by Professor Tim McHugh from the Royal Free) are the longest established. Whilst focussed on delivery of high quality research, relevant to the location, our collaborations have been underpinned by a commitment to capacity development both in people and infrastructure.

A number of researchers in the Centre are part of UCL's Institute for Global Health and the Institute's Grand Challenges programme; you can find out more about the Institute here.

Research in the Centre reflects the challenges presented by a diagnostic service in central London, thus our main research themes are:

Molecular diagnosis

Tuberculosis

Mycology

Respiratory infections

Evolution of antibiotic resistance

Hospital Acquired Infection

Support for our work comes from substantial funding from the EU, EDCTP (read more here), MRC, Wellcome Trust , NIHR and the Gates Foundation amongst others.

We believe that our training programmes for Clinical Microbiologists are second to none and course developments are grounded in our research practice and findings.

We provide programmes to undergraduate science and medicine students, postgraduate taught courses as well as providing academic support for continuing professional development for all grades of Health Care Scientist and Medical Trainees. Details of the programmes we run can be found here. The Centre provides research training through PhD and MD programmes closely aligned with our research interests.

UCL Grand Challenge of Global Health: 1-day conference on TB

Tuberculosis: Local and Global

Friday, 23 March, 8.30-6.30 at the Royal Free.The
UCL Institute for Global Health is marking World TB Day with a meeting that
addresses tuberculosis as a challenge to London and UK health services and sets
it in a global context, with the launch of Tuberculosis and TB/HIV;
Controversies and unanswered questions, a Journal of Infectious Diseases
special supplement edited by Professor Ali Zumla (UCL Centre for Clinical
Microbiology) and Marco Schito (National Institutes of Health, USA).

The meeting will be of interest to scientists,
clinicians and students. The conference is free to attend but registration
is required.

Tackling Tuberculosis on a Global Scale

World TB day, 24th March, commemorates the date in 1882 when Dr Robert Koch announced the dicovery of mycobacterium tuberculosis, the bacterium that causes tuberculosis. Join us to explore UCL research on TB through a series of short presentations and posters.Everyone Welcome!

Date: 5 August, 2013This research programme is made up of a consortium of scientists from more that 14 countries
with skills in clinical trials, pulmonology, mycobacteriology, pharmacokinetics,
statistics and delivery of clinical service. This joint initiative comes from the recognition that only by working together across countries and disciplines can the spectre of TB be controlled.

PreDiCT-TB: http://www.predict-tb.eu/

Date: 2 July, 2013
This EU Innovative Medicines
Initiative (IMI) and European Federation of Pharmaceutical Industries and
Associations (EFPIA) funded proejct: "PreDiCT-TB: Model-based
preclinical development of anti-tuberculosis drug combinations" is in it's second year and the consortium have launched a project website at www.predict-tb.eu. The website shows the aims of the project and the work of the participants. UCL's work is led by Professor Tim McHugh.

World TB Day 2013: Targeting zero deaths from TB: progress, reality and hope

Date: 25 March, 2013

This year's World TB Day event featured speakers from around the
globe - to read an overview and selection of photographs from this highly
successful meeting follow the link: LINK

www.ucl.ac.uk/tb: the launch of a TB research website

Date: December 2012www.ucl.ac.uk/tb is a new website connecting researchers in UCL and across their networks with the aim of
improving research into TB, dissemination of research outcomes and new funding
opportunities for research groups. The website is run by Professor Tim McHugh.

World TB Day 2012: Tuberculosis: Local and global

Date: 23 March 2012

To
mark World TB Day 2012 the UCL Institute for Global Health held a
meeting to address tuberculosis as a challenge to London and UK health
services and set it out in a global context. The meeting also marked the
launch of 'Tuberculosis and TB/HIV: Controversies and unanswered
questions', a Journal of Infectious Diseases special supplement edited
by Professor Ali Zumla (UCL Centre for Clinical Microbiology) and Marco Schito (National Institutes of Health, USA). MORE

REMox TB achieves recruitment target (Jan 2012)

Dr Tim McHugh, Director of the Centre for Clinical Microbiology, is pleased to announce that the recruitment target of 1900 was achieved (final number 1904). REMoxTB
is a phase III regulatory clinical trial designed to test treatment
shortening regimens for tuberculosis. The ultimate outcome of REMoxTB is
a new regimen for treatment of TB and the study leaves a substantial
legacy the network of trials sites prepared to test the next generation
of compounds and regimens.

PanACEA - introduction to the Project (2011)

PanACEA, The Pan African Consortium for the Evaluation of
Antituberculosis Antibiotics, is an externally funded international
collaborative project exploring new drugs that have the potential to
shorten TB treatment.

One of the centre's biggest projects, PanACEA, The Pan African Consortium for the Evaluation of Antituberculosis Antibiotics, is an externally funded international collaborative project exploring new drugs that have the potential to shorten TB treatment.

World TB Day (24 March 2011)

Tackling Tuberculosis on a Global Scale

World TB day, 24th March, commemorates the date in 1882 when Dr Robert Koch announced the dicovery of mycobacterium tuberculosis, the bacterium that causes tuberculosis. Join us to explore UCL research on TB through a series of short presentations and posters.Everyone Welcome!

Lancet Seminar: Tuberculosis (March 18, 2011)

As
world TB day approaches on 24 March, The Lancet publishes a Seminar
Online First that reports that, with increasing rates of drug-resistant
TB, the progress being made for decades by world TB programmes is under
threat. It also discusses the how other risk factors, such as smoking
and diabetes, are increasingly important in fuelling the global burden
of TB.

The Seminar is by Professor Alimuddin
Zumla, University College London Medical School, UK, and Dr Stephen
Lawn, University of Cape Town, South Africa. (Press Release, Abstract, PDF)

TB Afternoon (3 November 2010)

A report and presentations from UCLP's Infection Theme's first TB afternoon can be seen here.

EDCTP & UK-TBD: Our Research Commitments

Support for our work comes from substantial funding from the EU, EDCTP (read more here), MRC, Wellcome Trust , NIHR and the Gates Foundation amongst others. Our MRC-funded project to develop collaboration between TB research groups in the UK has it's kick-off conference in January - read more about TBD-UK here.

MAMS-TB trial stops recruiting patients to two arms (10 March 2014)

The MAMS-TB trial is a TB clinical trial with an innovative study design. The trial is being conducted by the PanACEA consortium, of whichUCL is a major partner; the MRC Clinical Trials Unit at UCL are
responsible for data analysis and the UCL Centre for Clinical Microbiology
provide the laboratory expertise.

The MAMS-TB trial aims to identify combinations of drugs that could shorten tuberculosis (TB) treatment. Standard TB treatment currently lasts around 6 months. The MAMS-TB trial is comparing 4 new combinations of drugs with the standard 6-month combination. It uses the innovating multi-arm, multi-stage approach, which allows several treatments to be assessed against a single control arm. Those that are not sufficiently promising can be dropped after interim analyses. This allows resources to be focused on those treatments that are most likely to be an improvement compared to the current standard treatment.

The trial is stopping recruiting patients to two of its arms. This
follows a meeting of the Independent Data Monitoring Committee (IDMC)
which looked at interim analyses. The IDMC recommended that the arms
testing the HRZQ and HR20ZQ combinations of drugs should be closed, as
the interim results were not promising enough. These two arms include
the drug SQ109 instead of ethambutol in the standard 6-month combination
with rifampicin given at the higher dose of 20mg/kg in the HR20ZQ arm.
Patients are still being recruited to the other three arms of the trial.

Professor Zumla chaired a meeting in April with representatives from 5 European country partners to discuss progress on their
multi-million euros EU-funded collaborative R&D programme grant on development
of new diagnostic platforms for rapid point of care screening for a range of
bacterial, viral and fungal pathogens from a single sputum sample within an
hour of obtaining the specimen.

The final platform will have inbuilt tech for it to run from solar power
so, if successful, it can be useful in developing countries at points of care.

"Infectious disease: TB's revenge."

Leigh Phillips' News feature in January's edition of "Nature" featured comments by Professor Tim McHugh on the extent of the threat of drug resistance strains of TB in the world.LINK TO NATURE ARTICLE. Date: 2 January, 2013.

Centre members Professor Alimuddin Zumla
(Professor of Infectious Diseases and International Health), Dr Justin
O’Grady (senior postdoctoral scientist) and Dr Vanya GANT (consultant
microbiologist, University College London Hospitals NHS Trust) have
successfully signed a contract with the EU, Brussels for six million
euros (£4.7 million pounds) they competitively obtained from European
Union programme entitled ‘Health Innovation’. At the first
partners meeting held at UCL earlier this month, Professor Zumla, Dr
Justin O’Grady and Dr Vanya Gant said they were “absolutely delighted to
receive this award since it consolidates our leadership of global
infectious diseases research and development and the special excellent
collaborative partnerships which UCLH and UCL have with our overseas
partners. They said they will use these monies to enhance their
existing fruitful collaborative research activities on bacterial
pneumonia, influenza and tuberculosis and to develop a diagnostic test
that will rapidly and detect the exact cause of serious lung
infections, which would allow the most appropriate specific antibiotics
to be prescribed quickly thus improving treatment outcomes. “It
provides an ideal opportunity for us to develop a unique
multidisciplinary network of clinicians, basic scientists, molecular
biologist, microbiologists linked in with industry to work in unison to
achieve a multiplier effect in improving the clinical treatment
management outcomes of respiratory infections, such as bacterial
pneumonia, tuberculosis and fungal infections” “There is a
great need for rapid, accurate molecular diagnostics tests capable of
identifying a large panel of causative microorganism/s to enable
appropriate microorganism-specific therapy to be rapidly initiated for
improved management outcomes” “This exciting grant award will
further enhance our collaborative activities between UCLH and UCL and
with our partners in Finland, Ireland and France, in the fight against
these killer respiratory diseases which kill millions of people each
year.”Date: 24 July 2012

"Should medical postgrad courses teach management skills?"

Date: 19 June, 2012Stephen
Hoare's article for The Guardian reported how changes in postgraduate
healthcare training will improve patient care. Professor Tim McHugh was
interviewed for this article.LINK TO GUARDIAN

The Health Show: TB Special

A film on the GeneXpert machine will be transmitted on Saturday 13 August 2011 on The Health Show as part of a TB special. The film features Dr Tim McHugh and Dr Bertie Squire and also includes: a feature on the new TMC 207 drug, a feature about tracing TB patients who don't take their treatment in Lesotho and a studio interview with Prof Ajit Lalvani from Imperial College, London.

The show and the films on the website cannot be seen in the UK but you can watch it live on www.rentadrone.org and you can watch it anytime on www.rockhopper.tv from the morning of Saturday 13 August 2011 (link to TB short films including GeneXpert). It can also be downloaded from the Rockhopper site 28 days after transmission. The GeneXpert film will be on the BBC website from 11 August 2011 (Thursday afternoon).

The transmission times are Saturdays at 10:10 and 20:10 GMT and on Sundays at 07:10 and 23:10 GMT. See link for more information about the show - http://bbc.in/ntogPP

Professor Ali Zumla has been awarded the Zambian Order of Distinguished Service (First Division) by the President of Zambia during the Zambia presidential award investiture ceremony on 24 October, during Zambia's independence day celebrations, at the Presidential State House in Lusaka. The award was made to recognise Professor Zumla's considerable achievements in medicine and international development.

He has been further honoured as winner of the Karolinska Institute's Annual Clinical Science Prize and will be delivering the his presentation ‘Questioning dogma in Medicine and Science – a lifetime’s perspective on infectious diseases’ on November 8 at Birkeaulan, Karolinska University Hospital, Huddinge, Sweden. Karolinska Institutet.

Under
the supervision of Professor Tim McHugh, the UCL Centre for Clinical
Microbiology continues to maintain several international ties with research and
development centres and institutions around the world. The aims of the
secondments are to provide an opportunity to investigate and explore
on-going and new challenges in research, and to encourage the sharing of
knowledge and resources between academic communities in different parts of the
world.

One
such collaboration is that which began in 2011 with Professor Professor John
Lindo’s team in the Department of Microbiology at the University of the West
Indies (UWI), Jamaica.

Each
year scientists at the Royal Free campus are given
the opportunity to carry out a 3 to 6 week research and development secondment
in the Department of Microbiology, UWI.

This
year, Ms
Chika Ozongwu, a Trainee Clinical Scientist (Microbiology) at the Royal
Free, travelled to Kingston to
undertake a 5 weeks’ long placement in the Molecular laboratory at UWI. She was
asked to assist with molecular research work with two members of their team: Ms Alcia
Jones, a PhD student, and Medical Consultant, Dr Camile Thompson. Chika provided
supervision and training on molecular techniques, in particular, DNA/RNA
extraction methods and conventional multiplex PCR.

The
research projects included work on the detection of plasmid-mediated Fluoroquinolone
resistance genes in Escherichia coli
isolates, and of carbapenemase genes; of extraction and detection of Trichomonas vaginalis associated virus
(TVV), and of Vitek validation using MALDI-ToF
isolates.

Whilst
in Jamaica, Chika gave an oral presentation entitled “Use of a real-time
multiplex PCR, to detect bacterial enteric pathogens directly from stool
samples”. This was an opportunity to share with the department some of the more recent developments within the Royal Free Hospital Microbiology diagnostic service.

Chika
report wholeheartedly supported her
secondment:

“This
secondment provided me with the opportunity to translate many of my laboratory
skills and practices to the team at UWI. Through observation, demonstration and
training, I was able to apply learned technique.

“Working
in Jamaica proved an extremely rewarding and enjoyable experience that required
me to adapt to working in a different environment.

“What’s
next for the staff and students at UWI Department of Microbiology? The team has
shown much enthusiasm towards the continued development of their laboratory,
and the department is currently working towards formal recognition of
competence in the form of accreditation.

“In
addition, the department is preparing to have a fully functioning containment
level 3 laboratory by 2014.

“Implementation
of both of these changes will require much planning and preparation and
therefore I feel this is an area that UCL could potentially assist in, as the
collaboration continues to strengthen.”

..

If photo carousel below does not open, click on the links below to see individual photographs of Chika's time in Jamaica: